ICU · Procedural

Tracheostomy in ICU: timing, technique, and weaning

Also known as Tracheostomy · Percutaneous tracheostomy · Surgical tracheostomy · Tracheostomy timing · Early vs late tracheostomy · Trach weaning

Tracheostomy in ICU: for patients expected to need prolonged mechanical ventilation. BENEFITS: patient comfort, easier secretion clearance, allows oral intake, potential for speech, potential for easier weaning. TIMING: controversial — early (within 4 days, TracMan) vs late (day 10 or later). TracMan: NO mortality benefit of early tracheostomy; meta-analyses suggest less pneumonia. Current: individualise once prolonged ventilation seems likely. TECHNIQUE: percutaneous dilatational (PDT — bedside, intensivist-performed, bronchoscopy-guided) vs surgical (OR — ENT/thoracic). PDT preferred (cheaper, faster, similar outcomes). COMPLICATIONS: bleeding, infection, displacement, tracheal stenosis, tracheo-oesophageal fistula.